Adrenal Insufficiency
Adrenal Insufficiency: Excerpt from A Pocket Manual of Differential Diagnosis
Primary
Autoimmune/idiopathic
Congenital/genetic
Adrenal aplasia or hypoplasia
Adrenoleukodystrophy/adrenomyelodystrophy
Congenital adrenal hyperplasia
Hereditary unresponsiveness to ACTH (familial glucocorticoid deficiency)
Drugs
Inhibition of cortisol biosynthesis
Aminoglutethimide
Metyrapone
o, p-Dichlorodiphenyldichloroethane (Mitotane)
Drugs that cause adrenal insufficiency in patients with limited pituitary or adrenal reserve
Etomidate
Ketoconazole
Spironolactone
Suramin
Trilostane
Acceleration of cortisol metabolism (usually causing adrenal insufficiency only in patients with limited pituitary or adrenal reserve, or patients on replacement glucocorticoid therapy)
Barbiturates
Phenytoin
Rifampin
Iatrogenic
Irradiation
Bilateral adrenalectomy
Infectious
AIDS
Cryptococcus
Cytomegalovirus
Lymphoma
Metastatic Kaposi's sarcoma
Mycobacterium avium complex
Toxoplasmosis
Tuberculosis
Fungal
Blastomycosis
Coccidioidomycosis
Cryptococcosis
Histoplasmosis
Moniliasis
Paracoccidioidomycosis
Torulopsosis
Syphilis
Tuberculosis
Infiltrative
Amyloidosis
Hemochromatosis
Sarcoidosis
Neoplastic
Leukemic infiltration
Lymphoma
Metastatic cancer
Vascular
Bilateral adrenal hemorrhage and/or infarction
Anticoagulants
Antiphospholipid syndrome
Arteritis
Coagulopathy
Emboli
Hypotension
Interleukin-2 therapy
Neonatal
Postadrenal venography
Pregnancy
Sepsis
Waterhouse-Friderichsen syndrome
Surgery
Thrombosis
Trauma
Secondary (Pituitary) or Tertiary (Hypothalamic)*
After removal of cortisol-secreting adrenal tumor
After withdrawal of drugs that suppress ACTH
ACTH
Glucocorticoids
Megestrol acetate
References
1. Orth DN, Kovacs WJ: The Adrenal Cortex, pp. 553–558. See Bibliography, 3.
2. Oelkers W: Adrenal Insufficiency.
N Engl J Med 335:1206–1212, 1996.
*See 4-S.
Book Source Details
- Book Title: A Pocket Manual of Differential Diagnosis
- Author(s): Stephen N. Adler, Dianne B. Gasbarra
- Year of Publication: 1999
- Copyright Details: A Pocket Manual of Differential Diagnosis, Copyright © 1999 Lippincott Williams & Wilkins.
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